Fundus bumper mechanical reference for easier mechanism deployment

ABSTRACT

Intrauterine devices and methods for facilitating deployment thereof using a bumper are disclosed. In one embodiment, an intrauterine device comprises a structure including a first central support member and a deployment mechanism coupled to the first central support member. The intrauterine device further comprises a bumper positioned at a distal end of a second central support member and at a more distal position relative to a distal end of the structure so as to prevent the distal end of the structure from contacting the fundus of the uterus of a patient during deployment of the deployment mechanism. In another embodiment, the intrauterine device comprises a bumper coupled to the deployment mechanism and configured to move from a more distal to a more proximal position relative to a distal end of the structure.

BACKGROUND

1. Field of the Invention

The present invention generally relates to intrauterine devices andmethods of deployment thereof.

2. Description of Background

Intrauterine medical devices are often inserted through a patient'scervix and then expanded inside the patient's uterus. For example, auterine ablation procedure may be performed by inserting a sheaththrough the cervix and then extending an applicator through the distalend of the sheath and expanding the applicator in the uterus. Theapplicator is expanded inside the patient, out of view of the personperforming the procedure. Reliable and proper positioning and deploymentof the applicator is important to avoid potential injury to the patient.Additionally, the applicator should reliably contract back into thesheath for removal from the patient.

SUMMARY OF INVENTION

Deployment of an intrauterine device in the uterine cavity may be ablind operation; for example, a physician may have no visual access tothe uterine cavity. Typically, deployment of an intrauterine device is amulti-step, technique-sensitive task largely based on physicianexperience, thereby increasing the risk of injury to the patient.Accordingly, aspects and embodiments of the present disclosure aredirected to providing intrauterine devices that may be deployed withease, particularly during the seating of the device in the uterinecavity. Aspects and embodiments are also directed to providing methodsfor facilitating deployment of intrauterine devices within the uterinecavity.

According to one aspect, an intrauterine device includes a structureincluding a first central support member and a deployment mechanismcoupled to the first central support member. The deployment mechanismmay be configured to extend from a collapsed position substantiallyaligned with the first central support member to a deployed positionflexing away from the first central support member. The intrauterinedevice further includes a second central support member that isdifferent from the first central support member and is disposedsubstantially parallel to the first central support member. Theintrauterine device further includes a bumper positioned at a distal endof the second central support member. The bumper may be arranged to beat a more distal position relative to a distal end of the structure soas to prevent the distal end of the structure from contacting a tissueof a uterus during deployment of the deployment mechanism. According toone embodiment, the tissue of the uterus of a patient may be a fundustissue and the bumper may be configured to provide a mechanicalpositional reference to the fundus.

In some embodiments of the intrauterine device, the bumper may bearranged to be at a more distal position relative to the distal end ofthe structure in both the collapsed position and the deployed positionof the deployment mechanism. In various embodiments, the bumper and thestructure may be constructed and arranged so that a movement of thebumper is controllable independently from a movement of the structure.The movement of the bumper may be controlled using the second centralsupport member.

In some embodiments, the first and second central support members may beconfigured to move relative to each other along a longitudinal directionof the first and second central support members so as to change aposition of the bumper relative to the distal end of the structure alongthe longitudinal direction. The first and second central support membersmay be arranged in a telescoping configuration. In some embodiments, thebumper may be configured to move to a retracted position when thedeployment mechanism is in a deployed position, the retracted positionbeing one of a more proximal position than the distal end of thestructure and a position that is substantially aligned with the distalend of the structure. Movement of the bumper to a retracted position isalong a longitudinal direction of the central support members. In someembodiments, the structure may be configured to support a mesh array andthe second central support member that is coupled to the bumper may beconfigured to move along the longitudinal direction within the mesharray.

In some embodiments, the deployment mechanism may be symmetric about thefirst and second central support members. The distal end of thestructure may include a plurality of tips. The plurality of tips may besubstantially aligned with the first and second central support membersin the collapsed position of the deployment mechanism and may bedisplaced away from the first and second central support members in thedeployed position of the deployment mechanism.

In some embodiments, the bumper may include a domed structure. Thebumper may be made of a soft material. In various embodiments, theintrauterine device may be an ablation device and the bumper may be madeof an electrically conductive material to facilitate ablation of thetissue of the uterus. For example, the bumper may include one or more ofa porous material, a hydrophilic material, a conductive polymer and amaterial infused with an electrically conductive particulate.

According to some embodiments of the intrauterine device having a secondsupport member coupled to the bumper, the bumper may include a thinflexible membrane disposed at least partially around the distal end ofthe structure in the collapsed position. The thin flexible membrane maybe configured to at least one of retract and flatten in the deployedposition so as to facilitate an approach of the structure to the tissueof the uterus in the deployed position. The thin flexible membrane maybe configured to conform to the tissue of the uterus in the deployedposition. The thin flexible membrane may be made of silicone. The thinflexible membrane may include one or more of a porous material, ahydrophilic material, a conductive polymer and a material infused withan electrically conductive particulate.

In some embodiments, the intrauterine device may further include amechanical force gauge configured to provide a measure of a forceexperienced by the bumper. The intrauterine device may further beconfigured to limit the force.

According to another aspect, an intrauterine device includes a structurehaving a first central support member and a deployment mechanism coupledto the first central support member. The deployment mechanism may beconfigured to extend from a collapsed position substantially alignedwith the first central support member to a deployed position flexingaway from the first central support member. The intrauterine devicefurther includes a bumper coupled to the deployment mechanism. Thebumper may be configured to move from a more distal position relative toa distal end of the structure to a more proximal position relative tothe distal end of the structure in response to extending the deploymentmechanism from the collapsed position to the deployed position, so as toprevent the distal end of the structure from contacting a tissue of auterus during deployment of the deployment mechanism. In someembodiments, the tissue may include a fundus of the uterus and thebumper may be configured to provide a mechanical positional reference tothe fundus.

In some embodiments of the intrauterine device, the bumper may be aflexible ribbon coupled to the deployment mechanism. The ribbon may besubstantially aligned with the first central support member in thecollapsed position of the deployment mechanism. The ribbon may furtherbe configured to substantially flatten along a direction substantiallyperpendicular to the first central support member in the deployedposition of the deployment mechanism so as to allow the structure tocontact the tissue of the uterus in the deployed position.

In some embodiments of the intrauterine device, the bumper coupled tothe deployment mechanism may be a thin flexible membrane disposed atleast partially around the distal end of the structure in the collapsedposition of the deployment mechanism. The thin flexible membrane may beconfigured to at least one of retract and flatten in the deployedposition of the deployment mechanism so as to facilitate an approach ofthe structure to the tissue of the uterus in the deployed position. Thethin flexible membrane may be configured to conform to the tissue of theuterus in the deployed position. The thin flexible membrane may be madeof silicone. The thin flexible membrane may include one or more of aporous material, a hydrophilic material, a conductive polymer and amaterial infused with an electrically conductive particulate.

In some embodiments of the intrauterine device having a bumper coupledto the deployment mechanism, the deployment mechanism may be symmetricabout the first central support member. The structure including thedeployment mechanism may further be configured to support a mesh array.The distal end of the structure may include a plurality of tips. Thetips may be the tips of the mesh array. The plurality of tips may besubstantially aligned with the first central support member in thecollapsed position of the deployment mechanism and may be displaced awayfrom the first central support member in the deployed position of thedeployment mechanism.

In some embodiments of the intrauterine device having a bumper coupledto the deployment mechanism, the intrauterine device may further includea mechanical force gauge configured to provide a measure of a forceexperienced by the bumper. The intrauterine device may further beconfigured to limit the force.

According to another aspect, a method for facilitating deployment of adeployment mechanism of an intrauterine device may be provided. Themethod may include acts of positioning a bumper of the intrauterinedevice at a more distal position relative to a distal end of thedeployment mechanism; advancing the mechanism into a uterus such thatthe bumper contacts a fundus of the uterus; and extending the deploymentmechanism from a collapsed position substantially aligned with a firstcentral support member of the intrauterine device to a deployed positionflexing away from the first central support member, the bumperpreventing the distal end of the deployment mechanism from contactingthe fundus during deployment of the deployment mechanism. In someembodiments, the method may further include an act of advancing thedeployment mechanism relative to the bumper in the deployed position.Advancing the deployment mechanism relative to the bumper may furtherinclude positioning the deployment mechanism such that the mechanismcontacts the fundus. In some embodiments, the acts of advancing themechanism into a uterus such that the bumper contacts a fundus of theuterus and extending the mechanism may overlap at least partially. Insome embodiments, the method may further include an act of flatteningthe bumper substantially simultaneously with extending the deploymentmechanism such that the deployment mechanism contacts the fundus in thedeployed position.

According to another embodiment, a method for facilitating deployment ofa structure including a deployment mechanism and a first central supportmember of an intrauterine device using a bumper configured to be at amore distal position relative to a distal end of the structure with thedeployment mechanism in a collapsed state may comprise acts of advancingthe structure with the deployment mechanism in the collapsed statethrough a cervix canal and into a uterus of a patient such that thebumper contacts a fundus of the uterus in the collapsed state; deployingthe deployment mechanism from the collapsed state to a deployed stateflexing away from the first central support member so that the bumperprevents the distal end of the structure from contacting the fundusduring deployment of the deployment mechanism; and causing thedeployment mechanism and the bumper to move relative to each other. Insome embodiments, the method may further comprise an act of furtheradvancing the structure in the deployed state so as to be closer to thefundus while the bumper maintains contact with the fundus.

In some embodiments, the acts of deploying the deployment mechanism andcausing the deployment mechanism and the bumper to move relative to eachother may overlap at least partially. The act of causing the deploymentmechanism and the bumper to move relative to each other may compriseflattening the bumper such that the bumper is aligned substantially withthe distal end of the structure. The act of causing the deploymentmechanism and the bumper to move relative to each other may comprisetelescoping a second central support member attached to the bumperwithin the first central support member.

Still other aspects, embodiments, and advantages of these exemplaryaspects and embodiments are discussed in detail below. Embodimentsdisclosed herein may be combined with other embodiments in any mannerconsistent with at least one of the principles disclosed herein, andreferences to “an embodiment,” “some embodiments,” “an alternateembodiment,” “various embodiments,” “one embodiment” or the like are notnecessarily mutually exclusive and are intended to indicate that aparticular feature, structure, or characteristic described may beincluded in at least one embodiment. The appearances of such termsherein are not necessarily all referring to the same embodiment.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of at least one embodiment are discussed below withreference to the accompanying figures, which are not intended to bedrawn to scale. The figures are included to provide illustration and afurther understanding of the various aspects and embodiments, and areincorporated in and constitute a part of this specification, but are notintended as a definition of the limits of the disclosure. In thefigures, each identical or nearly identical component that isillustrated in various figures is represented by a like numeral. Forpurposes of clarity, not every component may be labeled in every figure.In the figures:

FIG. 1 is a side elevation view of an intrauterine device with anapplicator in a retracted position according to aspects of the presentinvention;

FIG. 2 is a side elevation view of the intrauterine device of FIG. 1,showing the applicator in an extended position according to aspects ofthe present invention;

FIG. 3 is a perspective view of a portion of one embodiment of anintrauterine device in a collapsed position according to aspects of thepresent invention;

FIG. 4 is a perspective view of the portion of the intrauterine deviceof FIG. 3 in a deployed position according to aspects of the presentinvention;

FIG. 5 is a magnified view of a portion of the embodiment in FIG. 4;

FIG. 6 is a perspective view of the embodiment in FIG. 4, illustratingthe deployment mechanism advanced closer to the bumper according toaspects of the present invention;

FIG. 7A illustrates an exemplary embodiment of a portion of anintrauterine device seated in the uterus in a collapsed positionaccording to aspects of the present invention;

FIG. 7B illustrates an exemplary embodiment of a portion of theintrauterine device of FIG. 7A in a deployed position according toaspects of the present invention;

FIG. 8A illustrates an exemplary embodiment of a portion of anintrauterine device seated in the uterus in a collapsed positionaccording to aspects of the present invention;

FIG. 8B illustrates an exemplary embodiment of a portion of theintrauterine device of FIG. 8A in a deployed position according toaspects of the present invention;

FIG. 8C illustrates an exemplary embodiment of a portion of theintrauterine device of FIG. 8B, with the deployed mechanism advancedcloser to the bumper according to aspects of the present invention;

FIG. 9A illustrates a schematic view of an exemplary embodiment of aflexible thin membrane bumper disposed around a distal end of anintrauterine device according to aspects of the present invention;

FIG. 9B illustrates the flexible thin membrane bumper of FIG. 9A beingflattened in response to deploying the intrauterine device according toaspects of the present invention;

FIG. 10A illustrates an exemplary embodiment of a portion of anintrauterine device in a partially collapsed state according to aspectsof the present invention;

FIG. 10B illustrates an exemplary embodiment of a portion of theintrauterine device of FIG. 10A in a partially deployed state accordingto aspects of the present invention;

FIG. 10C illustrates an exemplary embodiment of a portion of theintrauterine device of FIG. 10A in a deployed position according toaspects of the present invention;

FIG. 11A is a perspective view of a portion of the intrauterine deviceof FIG. 10A in the partially deployed state according to aspects of thepresent invention;

FIG. 11B is a perspective view of a portion of the intrauterine deviceof FIG. 11A in a deployed position according to aspects of the presentinvention;

FIG. 12 is a perspective view of a portion of an exemplary embodiment ofan intrauterine device in a deployed position according to aspects ofthe present invention;

FIG. 13 is an elevation view of a portion of the intrauterine device ofFIG. 12 further illustrating a mesh array according to aspects of thepresent invention;

FIG. 14 is a perspective view of a portion of the intrauterine device ofFIG. 12 in a collapsed position according to aspects of the presentinvention;

FIG. 15 is a perspective view of a portion of an exemplary embodiment ofan intrauterine device in a deployed position according to aspects ofthe present invention;

FIG. 16 is an elevation view of a portion of the intrauterine device ofFIG. 15 further illustrating a mesh array according to aspects of thepresent invention;

FIG. 17 is an elevation view of a portion of the intrauterine device ofFIG. 16 according to aspects of the present invention;

FIG. 18 illustrates one embodiment of a method for facilitating thedeployment of a mechanism of an intrauterine device according to aspectsof the present invention;

FIG. 19A illustrates an exemplary embodiment of a portion of anintrauterine device having a flange and seated in the uterus in acollapsed position according to aspects of the present invention;

FIG. 19B illustrates the portion of the intrauterine device of FIG. 19Ain a deployed position according to aspects of the present invention;and

FIG. 20 illustrates one embodiment of a method for facilitating thedeployment of a mechanism of an intrauterine device having a flangeaccording to aspects of the present invention.

DETAILED DESCRIPTION

Aspects and embodiments of this disclosure are directed to providingvarious structures and methods for convenient and safe deployment of anintrauterine device. The intrauterine device may be an intrauterinetherapy application device including a deployment mechanism that may bedeployed within the uterus of a patient.

Deploying a deployment mechanism of an intrauterine device may includeadvancing the deployment mechanism to the fundus of the uterus andexpanding the deployment mechanism by repeatedly sliding the deviceproximally and distally about 0.5 cm as the deployment mechanism isexpanded from a collapsed position to a deployed position, lightlytapping against the fundus on each proximal stroke. Repeatedly slidingthe device back and forth prevents at least a portion of the deploymentmechanism, such as the tips disposed at a distal end of the deploymentmechanism, from being buried in the fundus tissue while the deploymentmechanism is expanding. However, this method relies on skillfulmanipulation of the device and repeated tapping against the fundustissue during deployment of the mechanism, which may be inconvenient anduncomfortable to the patient and may result in increased risk of injuryto the patient if a portion of the deployment mechanism becomes buriedin the fundus tissue during deployment due to unskillful manipulation.

According to one aspect of the present disclosure, convenient and safedeployment is achieved by providing an intrauterine device including abumper. The bumper may be disposed at a distal end of the intrauterinedevice. The bumper may be configured to prevent at least a portion ofthe deployment mechanism of the intrauterine device from being buried ina tissue of the uterus during deployment. In some embodiments, thebumper may be a fundus bumper. The fundus bumper may be configured toprovide a mechanical positional reference to the fundus.

According to another aspect of the present disclosure, convenient andsafe operation of an intrauterine device is achieved by providingmethods of facilitating the deployment of a mechanism of theintrauterine device. In some embodiments, a method of facilitatingdeployment may include positioning a bumper of the intrauterine deviceat a more distal position relative to the deployment mechanism. Themethod may further include advancing the deployment mechanism until thebumper contacts the fundus. The method may further include expanding thedeployment mechanism and preventing the deployment mechanism fromcontacting the fundus during deployment using the bumper. One advantageof this method is that it prevents the deployment mechanism frombecoming buried in the fundus tissue without requiring theabove-described user manipulation, including repeated tapping againstthe fundus tissue during deployment of the deployment mechanism, therebyallowing convenient and safe deployment of the mechanism.

It is to be appreciated that embodiments of the methods and apparatusesdiscussed herein are not limited in application to the details ofconstruction and the arrangement of components set forth in thefollowing description or illustrated in the accompanying drawings. Themethods and apparatuses are capable of implementation in otherembodiments and of being practiced or of being carried out in variousways. Examples of specific implementations are provided herein forillustrative purposes only and are not intended to be limiting. Inparticular, acts, elements and features discussed in connection with anyone or more embodiments are not intended to be excluded from a similarrole in any other embodiment.

Also, the phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limiting. Any references toembodiments or elements or acts of the systems and methods hereinreferred to in the singular may also embrace embodiments including aplurality of these elements, and any references in plural to anyembodiment or element or act herein may also embrace embodimentsincluding only a single element. The use herein of “including,”“comprising,” “having,” “containing,” “involving,” and variationsthereof is meant to encompass the items listed thereafter andequivalents thereof as well as additional items. References to “or” maybe construed as inclusive so that any terms described using “or” mayindicate any of a single, more than one, and all of the described terms.Any references to front and back, left and right, top and bottom, upperand lower, and vertical and horizontal are intended for convenience ofdescription, not to limit the present systems and methods or theircomponents to any one positional or spatial orientation.

Referring to the Figures, illustrated in FIG. 1 is an intrauterinetherapy application device 100 including an applicator 102, a sheath104, and an RF generator 110. As used herein, the terms applicator,applicator structure and structure may be used interchangeably and mayrefer to a structure of the applicator. According to one embodiment, thesheath is inserted through the patient's cervix. The applicator may beretracted in a collapsed position within the sheath for insertion intothe patient's cervix, as shown in the exemplary embodiment of FIG. 3. Asshown in FIG. 1, the applicator 102 is in a retracted position insidethe hollow sheath 104. The sheath may be inserted through the patient'scervix, and when the distal end 104 a of the intrauterine therapyapplication device 100 is inside the uterus, the applicator may beextended into the uterus in a collapsed position, and expanded into adeployed state in the uterus, as shown in the exemplary embodiment ofFIG. 4 and discussed further below.

The intrauterine therapy application device 100 includes a handle 106,and is coupled via a cable 120 to a radiofrequency signal generator 110and via a tube 128 to a vacuum source 112. The radiofrequency generator110 generates an electrical signal, for example a radiofrequency signal,and transmits it to the applicator 102 through the cable 120, which isultimately coupled to the applicator through the handle 106. The vacuumsource 112 is connected to the handle 106 at the vacuum port 122 andcreates suction in the distal end of the applicator 102.

The handle 106 includes a distal grip 124 and a proximal grip 126.During use, the proximal grip 126 is squeezed toward the distal grip124, to cause the applicator 102 to extend out from the sheath 104, asshown in FIG. 2. As shown in FIG. 2, the applicator 102 is extended outfrom the sheath 104 in a collapsed position. In some embodiments, as theapplicator 102 extends out from the sheath 104 in the collapsedposition, it may also expand as shown in the perspective view of thedeployed applicator illustrated in FIG. 4.

According to one feature, the distal end 104 a of the intrauterinetherapy application device 100 is configured to be inserted into apatient's cervix. The distal end 104 a includes a bumper according toaspects of the present disclosure. The bumper is configured to prevent adistal end of the applicator 102 from becoming buried in cervicaltissue, such as the fundus tissue, as the applicator 102 is expandedfrom a collapsed position to a deployed position.

FIG. 3 is a perspective view of a portion of one embodiment of anintrauterine device, including a bumper 200. The bumper 200 is disposedat the distal end of the intrauterine device. In one example, theintrauterine device may be the intrauterine therapy application device100 in FIG. 1. The intrauterine device further includes a sheath 202.The sheath is a hollow tube configured to house an applicator in acollapsed position. The applicator is retracted into the sheath 202 in acollapsed position and therefore is not visible in FIG. 3. Theapplicator includes tips 204 and 206 disposed at the distal end of theapplicator. When the applicator is in a collapsed position as shown, thebumper 200 is disposed at the distal end of the intrauterine device,which is at a more distal position relative to the tips 204 and 206.This allows the applicator to be deployed within the uterus of a patientwithout the risk of burying the tips 204 and 206 in uterine tissue, suchas the fundus tissue.

The bumper 200 is coupled to a central support member 208. In thecollapsed position of the applicator, each of the tips 204 and 206 issubstantially aligned along a longitudinal direction of the centralsupport member 208. The central support member 208 may be controlledindependently from the applicator. For example, the applicator may havea separate central support member configured to slide through the sheath202 to extend and retract the applicator. In the collapsed position, thetips 204 and 206 do not extend beyond the bumper 200. The centralsupport member 208 may be configured to slide through the sheath 202,thereby moving the bumper relative to the tips 204 and 206.

FIG. 4 is a perspective view of the portion of the intrauterine deviceof FIG. 3, including the sheath 202 and the bumper 200 disposed at thedistal end of the central support member 208. FIG. 4 further illustratesthe structure of the applicator 210 in a deployed position. Theapplicator 210 includes a deployment mechanism 212, a mesh array 214 andtips 204 and 206 disposed at the distal end of the applicator. Thedeployment mechanism 212 is coupled to a central support member (notshown) that is included in the applicator structure and is separate fromthe central support member 208 of the bumper 200. The central supportmember that is coupled to the deployment mechanism 212 is a firstcentral support member and the central support member 208 coupled to thebumper 200 is a second central support member that is different from thefirst central support member. The first and second central supportmembers are substantially parallel and configured to slide through thesheath 202. The first and second central support members may be arrangedin a telescoping configuration. The deployment mechanism 212 isconfigured to expand the applicator 210 from a collapsed position thatis substantially parallel to the central support members to a deployedposition flexing away from the central support members as shown in FIG.4.

The mesh array 214 surrounds the applicator 210. The mesh array 214 maybe knitted from a nylon and spandex knit and plated with gold, silver,or another conductive material. The mesh array 214 may be configured tobe conformable, permeable, and to carry current. The mesh array 214 maybe attached to at least a portion of the deployment mechanism 212, suchas external flexures of the deployment mechanism 212, with strands ofthread 216, as shown in FIG. 4. The strands of thread may be nylon. Thestrands of thread may be sewn through the mesh array 214 and around theexternal flexures. Some examples of a mesh array are described in U.S.Pat. No. 6,813,520 to Truckai et al., which is hereby incorporated byreference herein in its entirety.

FIG. 5 shows a magnified view of a portion of the mesh array 214 of FIG.4. The mesh array 214 may be configured to allow the central supportmember 208 to slide through the mesh array. For example, as shown inFIG. 5, portions of the mesh array 214 may be held together usingstrands of thread 218 sewn around the central support member 208. Thestrands of thread 218 may be sewn loosely around the central supportmember 208 to reduce friction between the mesh array 214 and the centralsupport member. In some embodiments, the bumper 200 may be coupled to aplurality of central support members. In some embodiments, the centralsupport member 208 may include two rods as shown in FIG. 5, which arerigidly mechanically coupled to the proximal section of the intrauterinedevice. The coupling rods are woven through the center stripe of themesh array 214 to help center the bumper.

Referring again to FIG. 4, as the applicator structure 210 deploys, thetips 204 and 206 shift away from the central support member 208, therebyleaving a gap 220 between the bumper 200 and the applicator structure ina longitudinal direction along the central support member. Duringdeployment of the deployment mechanism, the bumper 200 remains at a moredistal position relative to the tips 204 and 206, guaranteeing that thebumper is resting against the fundus and that the tips do not engage thefundus during deployment. Following deployment of the deploymentmechanism, the bumper 200 may also remain at a more distal positionrelative to the tips 204 and 206. The bumper 200 may further beconfigured to move relative to the tips 204 and 206 following deploymentof the deployment mechanism. The central support members of each of theapplicator structure 210 and the bumper 200 may be configured to slideagainst each other in the longitudinal direction, thereby eliminatingthe gap 220 as shown in FIG. 6. The deployment mechanism 212 is advancedcloser to the bumper 200 in FIG. 6. As a result, the mesh array 214 mayapproach the uterine tissue after the deployment mechanism is deployed,allowing better contact between the applicator structure 210 and theuterine tissue. In the retracted position of the bumper 200 shown inFIG. 6, the bumper is substantially aligned with the distal end (tips204, 206) of the applicator structure 210. In some embodiments, thebumper may be configured to further move to a retracted position that isa more proximal position relative to the distal end (tips 204, 206) ofthe applicator structure 210 in the deployed position.

In the embodiments illustrated in FIGS. 4-6, the applicator structure210 is substantially symmetric around the central support member.However, other embodiments may include other configurations of theapplicator structure, such as asymmetric configurations around a centralsupport member of the intrauterine device. The central support membermay be coupled to a centrally positioned bumper, allowing the bumper tocontact the fundus.

The bumper may be configured to be inserted into a patient's cervix. Thebumper may include a domed end or structure. The bumper may be domed orrounded to mimic the tip of a dilator, facilitating smooth insertion.The bumper may be made of a soft material. In other embodiments, thebumper may be made of rigid materials such as rigid plastic.

Exemplary processes for operation of various embodiments of anintrauterine device having a bumper are illustrated and described withreference to FIGS. 7A to 7B and FIGS. 8A to 8C. These exemplaryprocesses may be applied using various embodiments of intrauterinedevices.

FIG. 7A illustrates one embodiment of a portion of an intrauterinedevice seated in a uterus in a collapsed position. In one example, theintrauterine device may be the embodiment described with reference toFIGS. 3 to 6. The intrauterine device includes a bumper 300 disposed atthe distal end of the device and contacting the fundus 308 of the uterus310. The intrauterine device further includes an applicator structure302 extending through a sheath 304 into the uterus 310. A centralsupport member 306 coupled to the bumper 300 may be used to control theposition of the bumper. As shown in FIG. 7A, the bumper 300 may bepositioned so as to leave a gap between the bumper and a distal end ofthe applicator structure 302, to prevent at least a portion of theapplicator structure 302 from contacting the fundus 308. In otherembodiments, a gap between the bumper and the distal end of theapplicator structure may be reduced or eliminated in the collapsedposition, as shown for example in FIG. 3.

FIG. 7B illustrates the embodiment of FIG. 7A in a deployed position. Asthe applicator structure 302 is deployed, the bumper 300 remains incontact with the fundus 308 and may contact the applicator structure.The tips 312 and 314 of the applicator structure 302 do not contact thefundus 308 during deployment due to the presence of the bumper 300. Theapplicator structure may include a deployment mechanism and a mesh arrayas described earlier and the tips 312 and 314 may be array tips.

FIG. 8A illustrates one embodiment of a portion of an intrauterinedevice seated in a uterus in a collapsed position. In one example, theintrauterine device may be the embodiment described with reference toFIGS. 3 to 6. The intrauterine device includes a bumper 400 and anapplicator structure 402 positioned within the uterus 404 such that thebumper contacts the fundus 406. The bumper 400 is also configured tocontact the distal end of the applicator structure 402 in the collapsedposition. FIG. 8B illustrates the embodiment of FIG. 8A in a deployedposition. As the applicator structure 402 is deployed, the bumper 400prevents the applicator structure from contacting the fundus 406. In thedeployed position, there may be a gap between the bumper 400 and thedeployed applicator structure 402, which may be reduced or eliminated byadvancing the applicator structure towards the bumper, as shown in FIG.8C. In some embodiments, the applicator structure 402 may be deployedwhile advancing the applicator structure towards the bumper 400, suchthat when the applicator structure is completely deployed, it contactsthe bumper.

As illustrated in the embodiments of FIGS. 7A-7B and 8A-8C, the bumperremains a stationary reference at the fundus while the applicatorstructure deploys. The intrauterine device may be configured such thatmovement of the bumper may be controlled independently of the movementof the applicator structure. In some embodiments, the intrauterinedevice may be configured to control the motion of the bumper and arraytips of the applicator structure relative to each other. In someembodiments, the intrauterine device may include a disposable hand piececonfigured to control the motion of the bumper and the deploymentmechanism of the applicator.

According to an aspect of the present disclosure, it may be best for thebumper to take up as little space as possible following deployment ofthe applicator structure, so as not to prevent intimate contact betweenthe applicator and the fundus.

FIG. 9A illustrates an exemplary embodiment of a flexible thin membranebumper disposed around a distal end of an intrauterine device. Thebumper 500 is thin and flexible and is positioned on, but not fixed to,the rounded tips 504 and 506 of the applicator structure 502, therebyproviding a rounded dilator profile. The bumper 500 and the tips 504 and506 are configured to mimic a dilator as the device passes through thecervical canal 508 into the uterus 510. In some embodiments, theflexible thin membrane bumper may be flat in the resting state. Whilebeing passed through the cervical canal, the bumper may be soft enoughto fold over the tips, taking more of a domed shape. In otherembodiments, the flexible thin membrane bumper may be rounded in theresting state.

In some embodiments, the flexible thin membrane bumper may be coupled toa second central support member that is separate from a first centralsupport member, as shown for example in FIG. 4, wherein the firstcentral support member is coupled to a deployment mechanism of theintrauterine device. The second central support member may be controlledindependently from the first central support member. In otherembodiments, an intrauterine device having a flexible thin membranebumper may not include a second central support member. In theseembodiments, the flexible thin membrane bumper may be coupled to atleast a portion of a deployment mechanism of the intrauterine device andmay further be configured to retract from a more distal positioncompared to a distal end of the applicator structure 502 (such as moredistal than the tips 504, 506 as shown in FIG. 9A) to a more proximalposition compared to the distal end of the applicator structure 502(such as more proximal than the tips 504, 506 as shown in FIG. 9B)during deployment of the deployment mechanism of the applicatorstructure.

In some embodiments, the bumper 500 may be made of silicone. As theapplicator structure 502 is deployed, the material of the bumper 500 maybe flexible enough to easily flatten, allowing a portion of theapplicator structure, such as a mesh array, to make good contact withthe fundus. Establishing good contact between the mesh array and thefundus allows for better application of therapy to the fundus tissue.

FIG. 9B illustrates the flexible thin membrane bumper 500 of FIG. 9Abeing retracted and flattened in response to deploying the applicatorstructure 502 within the uterus 510. The flexible thin membrane bumper500 flattens as the tips 504 and 506 of the applicator structure 502 arespread apart during deployment. The bumper 500 is configured to conformto the fundus 512, facilitating improved contact between the mesh arrayof the applicator structure 502 and the fundus. In the deployedposition, the bumper 500 may be retracted to a more proximal positionrelative to a distal end (tips 504, 506) of the applicator structure502.

In some embodiments, the intrauterine device may be an ablation device.The bumper may be configured to allow electrical conductivity throughthe bumper, to ensure that it does not act as an insulator and locallyprevent ablation of uterine tissue. In various embodiments, the bumpermay be made of or may include one or more of a porous material, ahydrophilic material, a conductive polymer and a material infused withan electrically conductive particulate.

In some embodiments, an intrauterine device having a bumper according toaspects disclosed herein may further include a mechanical force gauge.The mechanical force gauge may used in conjunction with the bumper. Amechanical indicator, such as a scale or a dial, may be included in thedevice, for example, to provide a physician with a measure of the forceexperienced by the bumper. In one example, rather than reporting a forcevalue, a colored go/no-go indicator may be provided. One advantage of amechanical force gauge is to alert a physician if they were pressing toohard against the fundus. In some embodiments, the intrauterine devicemay further be configured to limit the axial force that a physiciancould apply to the bumper, thereby reducing the risk of excessiveloading and risk of injury to a patient.

According to an aspect of the present disclosure, an intrauterine deviceincluding a deployment mechanism may further include a bumper that iscoupled to the deployment mechanism. The movement of the bumper may becoupled to the deployment of the mechanism. In one embodiment, as themechanism is deployed from a collapsed position to a deployed position,the bumper moves from a more distal position to a more proximal positioncompared to a distal end of the intrauterine device, wherein themovement of the bumper from a more distal position to a more proximalposition is along a longitudinal direction of a first central supportmember that is coupled to the deployment mechanism. One embodiment of anintrauterine device including a bumper coupled to the deploymentmechanism was described in relation to FIGS. 9A and 9B, wherein theflexible thin membrane bumper may be coupled to the deploymentmechanism.

FIG. 10A illustrates another embodiment including a bumper 600 coupledto a deployment mechanism 602 of an intrauterine device. The bumper 600is configured as a ribbon with each end of the ribbon coupled to thedeployment mechanism 602. The center of the ribbon is aligned with acentral support member of the intrauterine device and the ends of theribbon are coupled to the deployment mechanism at symmetric locationspositioned on either side of the central support member. In someembodiments, the ribbon may be made of stainless steel. The ribbon maybe welded to internal flexures of the deployment mechanism 602. Thedeployment mechanism 602 is configured to support or include a mesharray. The deployment mechanism 602 is a part of an overall applicatorstructure of the intrauterine device, as previously described. Theapplicator structure also includes the tips 604 and 606. In otherembodiments, the deployment mechanism 602 may include the tips 604 and606.

In FIG. 10A, the deployment mechanism 602 is shown to be partiallydeployed, with the bumper 600 being positioned at the distal end of theintrauterine device, thereby preventing a distal end of the applicatorstructure, such as the tips 604 and 606, from contacting the fundustissue. The bumper 600 is configured to contact the fundus when thedeployment mechanism 602 is in a collapsed position and to provide amechanical positional reference to the fundus.

As the deployment mechanism 602 extends from a collapsed position to adeployed position, the tips 604 and 606 spread apart from each other andthe bumper 600 gradually retracts as shown in FIGS. 10B and 10C. Thisconfiguration of the bumper 600 prevents the tips 604 and 606 frombecoming buried in the fundus during deployment, while allowing theapplicator structure to contact the fundus in the deployed position inorder to enhance effectiveness of the therapy application. As thedeployment mechanism 602 expands, the shape of the ribbon bumper 600 isaltered. The ribbon's length and stiffness may be selected to allow theribbon to protrude ahead of the tips 604 and 606 while the device iscollapsed, and to gradually retract as the tips spread.

The ribbon bumper 600 may be made of a flexible material. In thecollapsed position of the deployment mechanism 602, the ribbon may becollapsed or folded such that it is substantially aligned with a centralsupport member of the intrauterine device. The central support member(not shown) may be positioned along the axis 608 shown in FIGS. 10A to10C. The central support member may be included in the applicatorstructure and coupled to the deployment mechanism 602. In the deployedposition of the deployment mechanism 602, the ribbon bumper 600 maysubstantially flatten along a direction substantially perpendicular tothe central support member positioned along axis 608 of the intrauterinedevice, as shown in FIG. 10C. The ribbon configuration may allow goodcontact between the mesh array and the fundus such that it may notimpact the ablation profile of the intrauterine ablation device.

FIG. 11A is a perspective view of a portion of the intrauterine deviceof FIG. 10A, illustrating the ribbon bumper 600, the deploymentmechanism 602, the tips 604 and 606 and the axis 608 along which acentral support member is aligned, as described previously in relationto FIGS. 10A to 10C. FIG. 11B is a perspective view of the embodiment ofthe intrauterine device of FIG. 11A in a deployed position.

Some embodiments including a bumper coupled to the deployment mechanism,such that the bumper automatically retracts as the deployment mechanismdeploys, may function passively. In these embodiments, the bumper maynot be controlled independently from the deployment mechanism.Therefore, there may be no need for an additional support member for thebumper. In other embodiments, such as that illustrated in FIGS. 3 to 6,the bumper may be coupled to an independently controlled central supportmember. The independently controlled central support member may includegrips and springs in the proximal part of the intrauterine device.

FIGS. 12-17 illustrate some examples of applicator structures anddeployment mechanisms that may be used, for example, in variousembodiments of an intrauterine device having a bumper according toaspects of the present disclosure.

FIGS. 12 and 13 illustrate an intrauterine device applicator structure702 in a deployed position. The applicator structure 702 may include amesh array 742 as shown in FIG. 13. In some embodiments, the deploymentmechanism may be configured to spread the mesh array 742 from acollapsed state into a deployed state. In some embodiments, the mesharray is knit from elastic yarn, so a certain level of force is neededsimply to spread the mesh array to the desired shape. In addition tostretching the mesh array, the deployment mechanism must be capable ofgenerating additional spreading force to ensure that the deploymentmechanism still opens properly if resistance is encountered.Simultaneously, it is desirable for the deployment mechanism to be assmall as possible and to be as mechanically durable as possible.

In some embodiments, the deployment mechanism includes internal flexures(see 760, 762 of FIGS. 12 and 13) and external flexures (see 756, 758 ofFIGS. 12 and 13). In a deployed position, external flexures (756, 758 ofFIGS. 12 and 13) define the outer contour of the structure, and internalflexures (760, 762 of FIGS. 12 and 13) facilitate reliable deployment ofthe structure from the sheath into a collapsed position and into adeployed position as well as retraction of the structure into thecollapsed position and into the sheath.

The structure 702 of FIGS. 12 and 13 may be spread open by driving aninternal central support member 754 forward relative to an externalcentral support member 752. Depending on the forces provided by thedrive mechanism used to actuate the internal central support member, theapplicator structure may or may not open to its maximum width. In someembodiments, the intrauterine device may include a compliant element,such as a spring, between the drive mechanism and the internal centralsupport member 754. The spring transmits force to the internal centralsupport member, so that if the external flexures are unrestricted, theflexures will deploy normally to their full width. Alternatively, in theevent that the tips of the flexures somehow become restricted, thespring can absorb driving force, allowing the flexures to rest at asub-maximum width without heavy stress. Thus, the introduction of acompliant element allows for a simple drive mechanism that drives adeployment mechanism that can automatically open to variable maximumwidths (i.e. opening to fill a cavity of unknown size). It also controlsthe spreading force that the deployment mechanism is able to generate.

Referring to FIG. 12, the applicator structure 702 includes an externalcentral support member 752, an internal central support member 754,external flexures 756 and 758 and internal flexures 760 and 762. Theproximal end of the internal central support member 754 is coupled tothe distal end of the external central support member 752, so as toprovide a telescoping arrangement. The proximal ends 756 a and 758 a ofthe external flexures 756 and 758 are attached to the outside of theexternal central support member 752 near the distal end of the externalsupport member 752. The proximal ends 760 a and 762 a of the internalflexures 760 and 762 are attached to the outside of the internal centralsupport member 754, near the proximal end of the internal centralsupport member 754. It is to be appreciated that in other embodiments,the proximal ends 760 a and 762 a of the internal flexures 760 and 762may be attached to the inside of the internal central support member754, or the proximal ends 760 a and 762 a of the internal flexures 760and 762 may be attached into the wall of the internal central supportmember 754. The external flexures 756 and 758 and the internal flexures760 and 762 are attached to the external 752 and internal 754 supportmembers such that the external flexures 756 and 758 and internalflexures 760 and 762 lie in the same plane.

The external flexures 756 and 758 in one position extend outward awayfrom being parallel with the central support members 752 and 754 to forma V-shape. According to one embodiment, the external flexures 756 and758 extend laterally away from the external central support member 752,flaring outwards toward the distal ends 756 b and 758 b. Similarly, theinternal flexures 760 and 762 extend laterally away from the internalcentral support member 754, forming a flared V-shape. The secondsections 760 b and 762 b of the internal flexures 760 and 762, adjacentto the proximal ends 760 a and 762 a, gradually extend laterally awayfrom the internal central support member 754. A third section 760 c and762 c of each internal flexure 760 and 762 extends substantiallylaterally and longitudinally away from the internal central supportmember 754. The distal end 760 d of the first internal flexure 760 isattached to a distal end 756 b of the first external flexure 756, and adistal end 762 d of the second internal flexure 762 is attached to thedistal end 758 b of the second external flexure 758.

As shown in FIG. 12, the central support member of the device applicatorstructure 702 includes external central support member 752 coupled tointernal central support member 754. In other embodiments, theapplicator structure 702 may include three or more support memberscoupled together. The external 752 and internal 754 central supportmembers may move relative to one another. In one example, the external752 and internal 754 central support members may be telescoping supportmembers. In another example, the external 752 and internal 754 centralsupport members may be slidably coupled together.

In some embodiments, as shown in FIG. 12, a transverse ribbon 764 mayextend between the distal ends 756 b and 758 b of the external flexures756 and 758. In one example, the transverse ribbon 764 may be configuredto provide lateral support for a mesh array. In one embodiment, thetransverse ribbon has a corrugated shape, and includes a plurality ofcreases 766 and 768, such that when the intrauterine device is in thecollapsed position, as shown in FIG. 14, the transverse ribbon 764 isfolded along the creases 766 and 768. In some embodiments, thetransverse ribbon may be configured to be a ribbon bumper as describedfor example in relation with FIGS. 10A-10C and 11A-11B. In otherembodiments, the intrauterine device may include a bumper in addition tothe transverse ribbon. In one example, the bumper may be coupled to asecond central support member as shown for example in FIG. 4 and thetransverse ribbon may provide an opening to allow the second centralsupport member to pass through it. The ribbon bumper may be configuredto prevent a distal end of the applicator structure from becoming buriedin the fundus tissue of the uterus of a patient, and the transverseribbon may be configured to provide lateral support for the applicatorstructure. In yet other embodiments, as will be described for example inrelation with FIGS. 15-17, the intrauterine device may not include atransverse ribbon.

Referring back to FIG. 12, according to one embodiment, the externalcentral support member 752 and the internal central support member 754are hollow elongate tubes. When a suction is applied to the applicatorstructure 702, for example from the suction source 112 shown in FIG. 1,fluid, vapor, liquid, and/or tissue may be suctioned through hollowelongate tubular internal support member 754, away from the patient.

According to one embodiment, the external flexures 756, 758 and internalflexures 760, 762 include multiple apertures 772. During use inside apatient, the apertures allow fluid, vapor, liquid and/or tissue to flowthrough the flexures and move within the uterus. In some embodiments, asshown in the illustrative embodiment, the transverse ribbon 764 alsoincludes multiple apertures.

FIG. 13 is a perspective view of the applicator structure 702 in adeployed position and having a mesh array 742. The mesh array 742surrounds the applicator structure 702. As previously discussed, themesh array 742 may be knitted from a nylon and spandex knit and platedwith gold, silver, or another conductive material. The mesh array 742 isconformable, permeable, and carries current. The mesh array 742 isattached to the external flexures 756, 758 with strands of thread 740 aand 740 b. The strands of thread 740 a, 740 b may be nylon. The strandsof thread 740 a, 740 b are sewn through the mesh array 742 and aroundthe external flexures 756, 758.

FIG. 14 is a perspective view of the applicator structure 702,illustrating the deployment mechanism in a collapsed position. In thecollapsed position, the external flexures 756, 758 and the internalflexures 760, 762 of the deployment mechanism extend substantiallyparallel with the external 752 and internal 754 central support membersof the applicator structure 702. The transverse ribbon 764 is foldedalong the creases 766, 768 shown in FIG. 12. The applicator 102described with respect to FIG. 1 may include the applicator structure702 of FIG. 4. During use of an intrauterine device, such as the device100 described with respect to FIG. 1, the applicator structure 702 maybe in a collapsed position inside the sheath 104 while the sheath 104 isinserted through the cervix. When the applicator 102 is extendeddistally from the distal end of the sheath 104, it expands to thedeployed position shown in FIG. 12.

According to any of the embodiments disclosed herein, the ribbon 764shown by way of example in FIGS. 12 and 13 may be replaced withalternative mesh support designs. It is appreciated that the ribbon 764shown in FIGS. 12 and 13 may take up a substantial amount ofcross-sectional space in the collapsed position, as shown by way ofexample in FIG. 14. FIGS. 15-17 show portions of intrauterine deviceswith alternative embodiments of arms to support a mesh array. The armsmay be used in place of a ribbon, for example, to reduce the outerdiameter of an intrauterine device in a collapsed position. Reducing theouter diameter of an intrauterine device improves its ease of insertionand decreases patient discomfort. According to various examples, themesh support arms mechanically support the distal end of the mesh array,preventing the mesh array from pulling back proximally and/or toward thecentral support members. Additionally, the mesh support arms providevertical support, mechanically separating the top of the mesh array fromthe bottom of the mesh array, which may help prevent an alternatingcurrent short through the mesh array when energy is delivered to themedical device after it is inserted in a patient.

FIG. 15 is a perspective view of a portion of another embodiment of anintrauterine ablation device applicator structure 850 having arms 862,864 shown in an expanded position. The applicator structure 850 includesa central support member 852, external flexures 854, 856, internalflexures 858, 860, and arms 862, 864. The proximal ends 862 a, 864 a ofthe arms 862, 864 are coupled to a middle portion 858 b, 860 b of theinternal flexures 858, 860. The arms 862, 864 curve laterally outward,and then curve back in toward the center line defined by the centralsupport member 852. The distal ends 862 b, 864 b of the arms 862, 864are directed inward toward the center line.

FIG. 16 is an elevation view of a portion of the intrauterine ablationdevice applicator structure 850 of FIG. 15 with a mesh array cover 868disposed thereabout. FIG. 17 is an elevation view of a portion of theintrauterine ablation device applicator structure 850 of FIG. 15 havinga mesh array anchored to the arms 862, 864 in multiple locations 870a-d, 872 a-d. By anchoring the arms to the array in one or morelocations, the system relies on the combined strength of the armsinteracting with the array, providing improved mechanical strength androbustness of the system without increasing the size of the arms.According to one feature, the arms 862, 864 prevent the top and bottomparts of the mesh array from coming in contact with one another.According to another feature, the arms 862, 864 prop up the distal endof the mesh array.

As discussed above, decreasing the thickness of the structure thatmaintains the extension of the mesh array at the distal end of theapplicator structure 852 allows for a decreased outer diameter of asheath enclosing the applicator structure 852 in a retracted position.The applicator structure 852 includes only two arms 862, 864, which areattached to the internal flexures 858, 860 distal to the distal end ofthe central support member 852. Thus, the applicator structure 852 canbe positioned within a substantially smaller diameter sheath in theretracted position than, for example, the applicator structure 702 shownin FIGS. 12-14.

The applicator structure 850 described with respect to FIGS. 15-17 maybe included in the various embodiments of the intrauterine devices asdescribed for example in FIGS. 3-6 and FIGS. 10A-10C. In one embodiment,the applicator 210 of FIG. 4 may be the applicator structure 850 of FIG.15, the mesh array 214 may be the mesh array 868 illustrated in FIGS. 16and 17 and the deployment mechanism 212 may include for example theflexures 854, 856, 858, 860 of the applicator structure 850 of FIG. 15.In one embodiment, a bumper may be coupled to an independentlycontrolled central support member that extends through the centralstripe 866 of the mesh array 868 as shown in FIGS. 16 and 17. In anotherembodiment, a ribbon bumper as described for example with respect toFIGS. 10A to 10C may be included in an intrauterine device having theapplicator structure 850 of FIGS. 15-17.

According to another aspect of the present disclosure, methods offacilitating deployment of an intrauterine device may be provided. FIG.18 illustrates one example of a method 900 for easier deployment of anintrauterine device having a deployment mechanism, using a bumper. Themethod 900 may include providing or obtaining an intrauterine devicehaving a bumper according to aspects disclosed herein. The bumper may bepositioned at a more distal position relative to a distal end of astructure including the deployment mechanism of the intrauterine device.The bumper may be at a more distal position with the deploymentmechanism in a collapsed state. For example, the bumper may bepositioned as shown in the various embodiments illustrated in FIG. 3,FIG. 7A, FIG. 8A, FIG. 9A and FIG. 10A.

Method 900 may include an act 910 of advancing the structure with thedeployment mechanism in a collapsed state through the cervical canal andinto the uterus of a patient such that the bumper contacts the fundustissue, as illustrated for example in FIG. 8A.

The method 900 may include an act 920 of deploying the deploymentmechanism such that the bumper prevents the deployment mechanism, andmore generally a distal end of the structure, from contacting the fundusduring deployment of the deployment mechanism, as shown for example inFIG. 8B. Deploying the deployment mechanism may include maintaining thebumper in contact with the fundus during deployment. Deploying thedeployment mechanism may include extending the deployment mechanism froma collapsed state or position substantially aligned with a centralsupport member of the intrauterine device (as shown for example in FIG.3) to a deployed state or position flexing away from the central supportmember (as shown for example in FIG. 4). The method 900 may furtherinclude an act of retracting the bumper. For example, the bumper may beretracted to be substantially aligned with a distal end of the structure(such as the tips of the structure as shown for example in FIG. 7B). Inanother example, the bumper may be retracted to be more proximal than adistal end of the structure.

The method 900 may further include an act 930 of advancing the structureincluding the deployment mechanism relative to the bumper, as shown forexample in FIG. 8C. Therefore, in the deployed position, the deploymentmechanism or the structure that includes the deployment mechanism may bepositioned at the distal end of the intrauterine device. Advancing thedeployment mechanism or the applicator structure may include or may beperformed simultaneously with an act of retracting the bumper relativeto the deployment mechanism or the applicator structure. Advancing thedeployment mechanism relative to the bumper may further includepositioning the deployment mechanism such that the deployment mechanismor the structure that includes the deployment mechanism contacts thefundus.

In some embodiments, advancing the deployment mechanism into the uterus,such as in act 910, may at least partially overlap with deploying thedeployment mechanism from a collapsed to a deployed position, such as inact 920. In some embodiments, deploying or extending the deploymentmechanism from a collapsed to a deployed position, such as in act 920,may at least partially overlap with advancing the deployment mechanismrelative to the bumper, such as in act 930. Advancing the deploymentmechanism relative to the bumper may include positioning the deploymentmechanism such that the deployment mechanism contacts the fundus. Insome embodiments, extending the deployment mechanism may further includeextending the deployment mechanism such that the deployment mechanismcontacts the fundus in the deployed position. In some embodiments, actsof retracting the bumper and deploying the deployment mechanism from acollapsed to a deployed position may overlap at least partially. In someembodiments, retracting the bumper may include flattening the bumper.The bumper may be gradually flattened while the deployment mechanism isgradually deployed, as shown for example in FIG. 9B and FIGS. 10A to10C. The bumper may be flattened such that the bumper is alignedsubstantially with a distal end of the structure. In some embodiments,the act of retracting the bumper may include telescoping a secondsupport member attached to the bumper with a first central supportmember coupled to the deployment mechanism.

Although various embodiments have been described as facilitatingdeployment of intrauterine devices, it is to be appreciated thatembodiments of the intrauterine devices and methods disclosed herein mayalso be used to facilitate contracting or collapsing the deploymentmechanism from a deployed position to a collapsed position. For example,the bumper may prevent a distal end of the applicator structure frombecoming buried in the fundus tissue during contraction of thedeployment mechanism. In some embodiments, the bumper may be retractedin the deployed position to allow a mesh array to contact the fundusduring application. Following therapy application, the bumper may beadvanced so as to prevent the mesh array or a distal end of theapplicator structure from contacting the fundus prior to contracting theapplicator structure. In some embodiments having a ribbon bumper coupledto the deployment mechanism, such as shown in FIGS. 10A to 10C, as thedeployment mechanism contracts from a deployed position to a collapsedposition, the ribbon bumper gradually advances so as to prevent thedistal end of the applicator structure or the deployment mechanism fromcontacting the fundus.

In one embodiment, the method 900 of FIG. 18 may further include acts tofacilitate collapsing the deployment mechanism of an intrauterinedevice. For example, the method may further include one or more ofretracting the deployment mechanism away from the bumper such that thedeployment mechanism does not contact the fundus, collapsing thedeployment mechanism from a deployed position to a collapsed positionwhile preventing the deployment mechanism from contacting the fundus,and retracting the collapsed deployment mechanism and the bumper awayfrom the fundus. The collapsed deployment mechanism may be retractedinto a sheath for removal from the patient. In some embodiments, thebumper may also be retracted into the sheath.

Another aspect is directed to providing an intrauterine device having aflange configured to facilitate deployment of a mechanism of theintrauterine device while preventing a distal end of the mechanism frombeing buried in the fundus tissue during deployment, as shown in FIGS.19A and 19B.

FIG. 19A illustrates an exemplary embodiment of a portion of anintrauterine device having a flange and seated in the uterus in acollapsed position. The intrauterine device includes an applicatorstructure 1000 extending through a sheath 1002 into the uterus 1006. Theintrauterine device further includes a flange 1004. The intrauterinedevice is configured such that a length of the device from the flange1004 to the distal end of the applicator structure 1000 is less than thesounding length from the external os 1010 to the fundus 1008. As theflange 1004 abuts the external os 1010, the distal end of the applicatorstructure 1000 is offset from the fundus 1008. In one example, theoffset may be around half a centimeter.

FIG. 19B illustrates the portion of the intrauterine device of FIG. 19Ain a deployed position. As the applicator structure 1000 is deployed,the tips located at the distal end of the applicator structure movealong the dotted lines and do not contact the fundus 1008. Theapplicator structure 1000 may be deployed while being advanced such thatin the fully expanded position the offset between the distal end of theapplicator structure and the fundus 1008 is eliminated. The applicatorstructure may include a deployment mechanism and a mesh array asdescribed earlier and the tips may be array tips.

FIG. 20 illustrates one embodiment of a method for facilitating thedeployment of a mechanism of an intrauterine device having a flange. Forexample, the intrauterine device may be the embodiment described withreference to FIGS. 19A and 19B. The method 1100 includes an act 1110 ofmeasuring the sounding length from the external os to the fundus. Themethod further includes an act 1120 of configuring the intrauterinedevice such that the length between the flange and the distal end of thedevice is less than the sounding length, as shown for example in FIG.19A. The method further includes an act 1130 of advancing the deviceinto the uterus until the flange abuts the external os, resulting in anoffset between the distal end of the device and the fundus, as shown inFIG. 19A. The method further includes an act 1140 of deploying thedeployment mechanism while advancing the deployment mechanism as shownfor example in FIG. 19B. In other embodiments, the deployment mechanismmay be advanced to eliminate the offset after deploying the mechanism.

Having described above several aspects of at least one embodiment, it isto be appreciated various alterations, modifications, and improvementswill readily occur to those skilled in the art. Such alterations,modifications, and improvements are intended to be part of thisdisclosure and are intended to be within the scope of the disclosure.Accordingly, the foregoing description and drawings are by way ofexample only, and the scope of the disclosure should be determined fromproper construction of the appended claims, and their equivalents.

What is claimed is:
 1. An intrauterine ablation device, comprising: anelongate tubular member configured for transcervical insertion; anelongate central member slidably disposed within the elongate tubularmember, the elongate central member comprising a distal bumper; and anenergy applicator operatively coupled to the elongate tubular member,the energy applicator comprising a tissue contacting member, and anexpandable-collapsible support structure underlying the tissuecontacting member, the expandable-collapsible support structurecomprising a first flexure having a first flexure distal tip and asecond flexure having a second flexure distal tip, wherein the first andsecond flexures are adjustable between a collapsed configuration, inwhich the first and second flexure distal tips are closely apposed tothe elongate central member and disposed proximally of and adjacent tothe distal bumper, and an expanded configuration in which the first andsecond flexure distal tips extend laterally in opposite directions awayfrom the elongate central member and the distal bumper; wherein thedistal bumper has an insertion profile at least as large as an insertionprofile of the expandable-collapsible support structure in the collapsedconfiguration, wherein the distal bumper is distal to the first andsecond flexure distal tips in the collapsed configuration and isconfigured to contact a fundal wall of the uterus upon distaladvancement of the elongate central member relative to the elongatetubular member within the uterus to thereby prevent the first and secondflexure distal tips from engaging the fundal wall during transition ofthe expandable-collapsible support structure from the collapsedconfiguration to the expanded configuration, and wherein the elongatecentral member and the expandable-collapsible support structure areconfigured to move relative to each other along a longitudinal directionof the elongate central member so as to change a position of the distalbumper relative to the first and second flexure distal tips.
 2. Theintrauterine ablation device of claim 1, wherein the distal bumper isfurther configured to move to a retracted position when theexpandable-collapsible support structure is in the expandedconfiguration, so that the distal bumper in the retracted position isdisposed proximally of the first and second flexure distal tips.
 3. Theintrauterine ablation device of claim 1, wherein the tissue contactingmember of the energy applicator and the distal bumper of the elongatecentral member are configured to deliver ablation energy to the tissueof the uterus.
 4. The intrauterine ablation device of claim 3, whereinthe distal bumper comprises an electrically conductive material,including one of a porous material, a hydrophilic material, a conductivepolymer and/or a material infused with an electrically conductiveparticulate.
 5. An intrauterine ablation device, comprising: an elongatetubular member configured for transcervical insertion; an elongatecentral member coaxially and slidably disposed within the tubularmember; an energy applicator operatively coupled to the elongate tubularmember, the energy applicator comprising a tissue contacting member andan expandable-collapsible support structure underlying the tissuecontacting member, the expandable-collapsible support structurecomprising a first flexure having a first flexure distal tip, and asecond flexure having a second flexure distal tip, with the elongatecentral member extending between the first flexure and the secondflexure, wherein the first and second flexures are adjustable between acollapsed configuration, in which the first and second flexure distaltips are closely apposed to the elongate central member, and an expandedconfiguration, in which the first and second flexure distal tips extendlaterally in opposite directions away from the elongate central member;and an elongate distal bumper having a first end coupled to the firstflexure and a second end coupled to the second flexure, so that when thefirst and second flexures are in the collapsed configuration, theelongate distal bumper is configured to arc, thereby forming an archbetween, and extend distally from, the first and second flexure distaltips, and when the first and second flexures are in the expandedconfiguration, the elongate distal bumper is configured to straightenbetween the first and second flexure distal tips, wherein the distalbumper is configured to contact a fundal wall of the uterus upon distaladvancement of the elongate central member relative to the elongatetubular member within the uterus to thereby prevent the first and secondflexure distal tips from engaging the fundal wall during transition ofthe expandable-collapsible support structure from the collapsedconfiguration to the expanded configuration.
 6. The intrauterineablation device of claim 5, wherein the elongate distal bumper comprisesa flexible ribbon and/or a thin flexible membrane configured to contacta fundal wall of a uterus.
 7. The intrauterine ablation device of claim5, wherein the elongate distal bumper is configured to conform to afundal wall of a uterus, and wherein the elongate distal bumper extendstransversely between the first and second flexure distal tips of theexpandable-collapsible support structure in the expanded configuration.8. The intrauterine ablation device of claim 5, wherein the elongatedistal bumper comprises an electrically conductive material, includingone of a porous material, a hydrophilic material, a conductive polymerand/or a material infused with an electrically conductive particulate.9. The intrauterine ablation device of claim 5, wherein the elongatedistal bumper is positioned distally of the energy applicator.